Vascular access in the neonate following extracorporeal membrane oxygenation

An infant maintained on extracorporeal membrane oxygenation (ECMO) has unlimited vascular access. When the infant is returned to conventional ventilator therapy, the need for vascular access persists for days to weeks. Providing alternative central venous access may be problematic, particularly while the infant is still heparinized during the first 12 hours after decannulation. In this study, secondary central venous catheters (CVC) were placed, at the time of decannulation, into the internal jugular vein from which the venous bypass cannula is removed. Fifty-four of 90 infants supported with ECMO had secondary CVCs placed (60%) and vascular access maintained for 2 to 122 days (mean, 17.5 days). Four catheters were removed for culture-proved line sepsis (7.4%). Neck wounds were reexplored for bleeding, while on bypass, in 2 of 4 patients in the sepsis group. There were no deaths related to catheter sepsis. Catheter-related septic infants had been on bypass for 50 to 88 hours (mean, 72.7 hours) as compared with 11 to 312 hours (mean, 104 hours) for the entire ECMO group, P = NS. This experience (942 catheter-days) suggests that secondary CVC placement into the vein used for bypass is safe with infectious complications comparable to catheters placed through primary wounds. Infants requiring neck explorations for bleeding while on bypass are not candidates for secondary CVC placement.